Development and validation of the short-form Ryff's psychological well-being scale for clinical nurses in Taiwan Tony Szu-Hsien Lee, Huey-Fang Sun, Hui-Hsun Chiang Journal of Medical Sciences 2019 39(4):157-162 Background: Research into clinical nurses' psychological well-being (PWB) is limited and fragmented. A reliable and valid measure is needed to advance the field of nurses' mental health. Objective: To examine the psychometric validity of Short-Form PWB Scale (PWBSs) among clinical nurses. Methods: This study adopted a cross-sectional design. Randomized cluster sampling was used to recruit clinical nurses from a medical center in Taipei, Taiwan, from July to October 2015. Nurses were recruited if they worked for more than 3 months in the medical center. The 84-item PWBS was used to assess PWB. Based on exploratory and confirmatory factor analysis in this study, an 18-item version of Ryff's PWBS was developed using 474 respondents. The Short-Form PWBS was tested for internal consistency, construct validity, and criterion-related validity. Results: Cronbach's alpha was 0.88, with aggregated subscale alphas of 0.72–0.88, except 0.57 for autonomy. Good construct validity and criterion-related validity of the Short-Form PWBS were found. Conclusions: The study results showed that the Short-Form PWBS is suitable and recommended for Taiwanese clinical nurses.

Expression of foreign proteins by antimicrobial peptide gene promoters in mosquitoes Chang-Chi Lin, Ying-Hsin Chen, Tzi-Chiang Guan, Shu-Wei Chang, Hsuan Pai, Shan-Ju Chou, Hui-Ping Tsai Journal of Medical Sciences 2019 39(4):163-171 Background: The mosquito Aedes aegypti is a major vector for transmission of viruses causing dengue fever, yellow fever, Zika, and chikungunya infection. Functional analysis of mosquito genes and individual viral genes can be a powerful approach to study vector–virus interactions but is often hampered by a lack of suitable promoters to drive exogenous viral gene expression in mosquito cells in vitro and in vivo. Object: To search for potential promoter candidates that can be used to express foreign genes and particularly viral proteins in a mosquito model system. Materials and Methods: we characterized the ability of the promoters of three Ae. aegypti antimicrobial peptide (AMP) genes to drive the expression of marker proteins (luciferase, GFP, the NS3 protein of two flaviviruses, and rabies virus glycoprotein) in mosquito cells and adult female mosquitoes, and in other insect cells as well. Results: The promoters of the defensin A4 and cecropin B1 genes produced robust expression of luciferase and GFP in the Ae. aegypti cell line CCL125, Aedes albopictus cell line C6/36, Drosophila melanogaster cell line S2, and Spodoptera frugiperda cell line Sf21. These AMP gene promoters also had the ability to drive NS3 and GFP expression in adult tissues of Ae. aegypti, Ae. albopictus, and Culex tritaeniorhynchus in vivo, which may suggest evolutionary conservation of AMP gene promoter activity across mosquito lineages. Conclusions: These promoters could provide a valuable tool for ectopically expressing viral genes and studying their interactions with the mosquito vectors.

Do anthropometrical indices correlate with pulse oximetry among children attending a private hospital in Enugu? Josephat M Chinawa, Bartholomew F Chukwu, Awoere T Chinawa Journal of Medical Sciences 2019 39(4):172-176 Background: Pulse oximetry remains the most common investigation in pediatric cardiology as it acts as a window to unravel most abnormalities in cardiac functions and structure. Objectives: The objective of this study was to determine what is actually the normative pulse oximetry reading among children and to determine if anthropometry has any effect on pulse oximetry. Methodology: A cross-sectional prospective study in which pulse oximetry readings were ascertained among healthy children attending a private clinic in Enugu over a 3-year period. Data Analysis: Data were analyzed using Stata 10 software (STATA 10, College Station, Texas, USA: Stata [Corp]) Means and 95% confidence intervals were calculated for all the individuals. The level of statistical significance was considered P < 0.05. Results: A total of 349 individuals were recruited consecutively. The median value of oxygen saturation (SpO2) was 98% (93%–99%). Females had a significantly higher SpO2 than the males (Wilcoxon-Mann–Whitney test, Z = 2.064, P = 0.04). There was a positive correlation between the SpO2 and age, weight, and height of the patients. Of these anthropometry, height is the most correlated with SpO2. On the other hand, there was a negative correlation between SpO2 and heart rate of the subjects (rho = −0.1845, P = 0.0005). There was no correlation between SpO2 and patient's body mass index (BMI). Conclusion: The normal oximetry reading among children in this study is 98% with a positive correlation with age, weight, and height and a negative correlation with heart rate but no correlation with patient's BMI.

Relationship between Helicobacter Pylori infection and gastric dysplasia: Results from histology of gastric samples in the South of Iran Ramin Niknam, Alireza Manafi, Seyed Alireza Taghavi Journal of Medical Sciences 2019 39(4):177-181 Background and Study Aims: Gastric dysplasia (GD) is a histologic premalignant lesion. Its significant lies in its strong association with the increased risk of developing gastric cancer. As there is no data about the frequency of Helicobacter pylori infection in histologic GD in the south of Iran, we designed the current study. Patients and Methods: In this cross-sectional study, we studied the frequency of H. pylori infection in consecutive cases with histologic diagnosis of GD; then, they were compared with a randomly selected group of age-matched participants whose histological diagnosis was normal or mild inflammation. The current study was conducted from November 2010 to January 2017 in Iran. Results: Of a total of 3521 patients, 126 cases with GD and 252 participants as the controls were enrolled. The mean age ± standard deviation of GD patients and controls was 50.25 ± 17.708 and 50.16 ± 17.388 years, respectively. Histologically, H. pylori infection was detected in 84.9% and 73.4% of the GD patients and controls, respectively. The frequency of H. pylori in the GD group was significantly higher than the comparison group (P = 0.012). On gastric endoscopic examination of patients with GD, 31 (24.6%) patients had normal endoscopy and others had abnormal endoscopic findings. Conclusions: In our study, the frequency of H. pylori in patients with GD was significantly higher than that of the comparison group. We recommend that further studies can be conducted to clarify the causal relationship of H. pylori infection and GD and also the impact of H. pylori eradication on the natural course of GD. We also recommend that further studies can be performed to determine the real association between endoscopic findings and GD.

Pediatric echocardiography in University of Nigeria teaching hospital, Ituku-Ozalla: “Real-world cardiology – Experience from a center in Nigeria” Ijeoma O Arodiwe, Josephat M Chinawa, Kunle E Obidike, Ikenna Omeje, OC Nzewi, Vivian O Onukwuli, Daberechi K Adiele, Fortune A Ujunwa Journal of Medical Sciences 2019 39(4):182-188 Objectives: The main objective is to showcase the overall pattern and distribution of cardiac diseases diagnosed by echocardiography and to highlight the difficulties encountered in delivering a Pediatric Cardiology/Cardiac Service at University of Nigeria Teaching Hospital. Materials and Methods: There were 308 children seen from July 2011 to June 2016. Their echo reports and case notes were retrieved and analyzed using SPSS version 20 (Chicago). Results: Their age range was from 3 days to 18 years mean (6.5 ± 4.2 years). One hundred and seventy-five (57.0%) were male and 133 (43.0%) were female with male: female ratio of 1.3:1. Of these, 211 had structural heart disease with 154 being congenital heart disease (CHD) and 57 were acquired heart disease, giving the prevalence of 0.44% and 0.16%, respectively. Isolated ventricular septal defect was highest acyanotic CHD with 44.1%, while tetralogy of Fallot was highest with 14.3% in cyanotic group. Some rare anomalies were also seen; one case of left ventricular noncompaction syndrome, Eisenmenger's syndrome, and Ebstein's anomaly representing 0.6%, respectively. The outcome was satisfactory with 35.5% receiving surgery with 7.7% mortality. The cost of procedures and dearth of interventional equipment were some of the challenges encountered. Conclusion: Although there exists low prevalence of echo diagnosed cardiac disease, a good number of them could not get surgical intervention due to cost.

Large erupted odontoma of the mandible: Report of a rare case Maryam Niazmand, Sepideh Mokhtari Journal of Medical Sciences 2019 39(4):189-192 Odontoma is the most common odontogenic tumors. Although usually asymptomatic, it is often associated with tooth eruption disturbances. In exceptional cases, the odontoma erupts into the oral cavity. Approximately 20 cases of erupted odontoma have been reported in the literature. In contrast to the usual cases of odontoma, erupted odontoma may be painful with swelling and infection. Here, we report a case of erupted odontoma in the posterior mandible. The second molar was impacted, and its distal root was severely dilacerated. This case seems to be one of the largest erupted odontomas reported in the literature. However, despite its large size, the lesion had no associated symptoms. Of consideration is the association of this case with root dilaceration of the impacted second molar and the presence of maxillary peg laterals. Since the impacted second molar had the anomaly of dilaceration, its chance for eruption was minimal. Therefore, the odontoma was excised and the second molar was extracted.

Solitary fibrous tumor of rectus sheath Po-Hsien Wu, Huai-En Lu Journal of Medical Sciences 2019 39(4):193-196 Solitary fibrous tumor (SFT) is a rare tumor with incidence <2% in all soft tissue tumors. About 30% of SFTs arise in thoracic cavity, 30% arise from the intra-abdominal cavity, and another 20% occur in head and neck. We presented a case with a painless, slow-growing intra-abdominal tumor for more than a decade. Physical examinations, blood test, and image studies provide little clues preoperatively. Definite diagnosis relies on pathological confirmation. Currently, there are numerous immunohistochemistry tools to facilitate making diagnosis correctly.

Yamaguchi syndrome – A pseudoacute coronary syndrome of the young: A case report on apical hypertrophic cardiomyopathy Alvin Oliver Payus, Farisha Mohd Sholeh, Norlaila Mustafa Journal of Medical Sciences 2019 39(4):197-199 Yamaguchi syndrome, or apical hypertrophic cardiomyopathy (ApHCM), is a nonobstructive subtype of hypertrophic cardiomyopathy which predominantly affects the left ventricular apex. Due to the nature of its presentation that mimics acute coronary syndrome and also to the unfamiliarity of the condition by some physicians, the diagnosis of ApHCM is frequently missed or delayed. Here, we report a case of a young male who presented with chest pain and breathlessness. His cardiac enzyme was normal and electrocardiogram showed giant negative T-waves. He was treated as unstable angina and was then subjected to a line of diagnostic procedures including coronary angiogram before he subsequently underwent ventriculogram which reveal a characteristic “spade-like” configuration over the left ventricle, in keeping with the diagnosis of ApHCM. The purpose of this case report is to emphasize the importance of keeping ApHCM as one of the differential diagnoses in a young patient presented with chest pain.

The manage strategy in a morbid obesity patient with bronchospasm during general anesthesia Wei-Lin Lin, Chueng-He Lu, Yuan-Shiou Huang, Nan-Kai Hung, Zhi-Fu Wu Journal of Medical Sciences 2019 39(4):200-202 During general anesthesia, anesthesiologists encounter problems including difficult airway intubation, high respiratory airway pressure, fluctuation of blood pressure, and poor oxygen saturation, especially in obese patients. In addition, obese patients with asthma or bronchospasm make these difficulties even more challenging. We present the case of a 37-year-old male with morbid obesity (height: 160 cm, weight: 120 kg, and body mass index: 47 kg/m[2]) with asthma attack and who was injured during a car accident that caused open fracture of the right patella which needed emergent open reduction and internal fixation surgery. He refused spinal anesthesia. By using rocuronium and its reversal agents sugammadex, lidocaine, β-2 agonist, epinephrine, sevoflurane, hydrocortisone, magnesium sulfate, and deep extubation, we were able to intubate smoothly and extubate successfully after the surgery without intensive care.

Use of smartphone in modern anesthesia and critical care Anubhav Sharma Journal of Medical Sciences 2019 39(4):203-204